title: Favorable outcomes for Native Hawaiians and other Pacific Islanders with severe traumatic brain injury.
abstract: Traumatic brain injury (TBI) disproportionately impacts minority racial groups. However, limited information exists on TBI outcomes among Native Hawaiians and other Pacific Islanders (NHPI). All patients with severe TBI (Glasgow Coma Scale (GCS) <9) who were hospitalized at the state-designated trauma center in Hawai'i from March 2006 to February 2011 were studied. The primary outcome measure was discharge Glasgow Outcome Scale ([GOS]: 1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; 5, good recovery), which was dichotomized to unfavorable (GOS 1-2) and favorable (GOS 3-5). Logistic regression analyses were performed to assess factors predictive of discharge functional outcome. A total of 181 patients with severe TBI (NHPI 27%, Asians 25%, Whites 30%, and others 17%) were studied. NHPI had a higher prevalence of assault-related TBI (25% vs 6.5%, P = .046), higher prevalence of chronic drug abuse (20% vs 4%, P = .02) and chronic alcohol abuse (22% vs 2%, P = .003), and longer intensive care unit length of stay (15±10 days vs 11±9 days, P < .05) compared to Asians. NHPI had lower prevalence of unfavorable functional outcomes compared to Asians (33% vs 61%, P = .006) and Whites (33% vs 56%, P = .02). Logistic regression analyses showed that Asian race (OR, 6.41; 95% CI, 1.68-24.50) and White race (OR, 4.32; 95% CI, 1.27-14.62) are independently associated with unfavorable outcome compared to NHPI. Contrary to the hypothesis, NHPI with severe TBI have better discharge functional outcomes compared to other major racial groups.
authors.affiliation: The Queen's Medical Center, Honolulu, HI 96813, USA.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Reid R
authors.initials: RR
authors.lastname: Hoshide
authors.forename: Susan M
authors.initials: SM
authors.lastname: Asai
authors.forename: Katherine G
authors.initials: KG
authors.lastname: Johnson
authors.forename: Juliet G
authors.initials: JG
authors.lastname: Beniga
authors.forename: Melanie C
authors.initials: MC
authors.lastname: Albano
authors.forename: Johnna L
authors.initials: JL
authors.lastname: del Castillo
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Donovan
authors.forename: Cherylee W
authors.initials: CW
authors.lastname: Chang
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Koenig
mesh_terms: D000328:Adult; D044466:Asian People / Q000208:ethnology; D001930:Brain Injuries / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006254:Hawaii / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000208:ethnology*; D012720:Severity of Illness Index; D044465:White People / Q000208:ethnology